Your Guide to Assisted Living Medicaid Rates

Transcript

00:00:07 - 00:01:03
All right, I think we're live. I don't know. Um, we're having this seems to be a little bit off today. Let's check my phone and see if I'm live on there. Um, all right. Yeah, we're live. So, welcome in everybody. Welcome to uh our video today. We're going to be talking about Medicaid. So, if you have been wondering about Medicaid, how Medicaid works, what fee schedules are, how how they're set for assisted living, what that's going to look like for you, um, and and you're

00:00:35 - 00:01:23
just kind of curious about what Medicaid is in general, uh, this is going to be a great video for you as as you're trying to get through this. It looks like we're not be we're not able to simoc cast onto LinkedIn today, and that's fine. We'll get we'll get a post up there. So, LinkedIn followers, um, sorry about that. We'll get you make sure you have a replay, though. And uh with that, yeah, just wanted to uh talk about Medicaid because Medicaid is something I see I I

00:00:59 - 00:01:55
have a lot of videos on Medicaid. I don't think very many other people talk about this, but it's something that uh I think a lot of people are interested in learning a little bit more about. Um for those of you who don't know um who I am, my name is Brandon. I have owned multiple assisted living facilities since 2020. I have worked professionally in government programs for over a decade and that includes Medicare, Medicaid, Medicare Advantage, uh, veteran type programs and I'm very familiar with

00:01:27 - 00:02:17
that. So, love sharing my knowledge on this. I help first-time assisted living entrepreneurs launch profitable purpose- driven businesses creating prosperity, purpose, and peace in their lives. So, super excited to be here with you. Stick around till the end of the video. We'll talk about a special opportunity to work with me here in the future. Uh or you can go to roadmapchallenge.com to learn a little bit more about that. And uh if you need some help and some guidance, get over to aliquiz.com. I have several

00:01:53 - 00:02:46
coaching programs. Would love to help you out with that. Again, it's aliquiz.com. 30 second quiz can help you out as you're trying to move things along. Um let's see. We're I'm getting all kinds of just weird messaging over here on my streaming software. So hopefully we're live and we're staying live. And if not, we'll we'll edit this and put it back up here in just a few minutes once we get done with with the video. Uh, but I did want to hop into this. Let's just get into the topic a

00:02:19 - 00:03:20
little bit today. Um, I want to I wanted to chat about uh just kind of what Medicaid is. We're going to go over that, help you understand what Medicaid is, uh, how it works, as well, how those payments actually work and what that looks like. because I've received a few comments recently on videos that are just like um you know I I have a video that talks about how we get uh $6,000 per bed in an assisted living facility for Medicaid. Um and so make sure you go watch that video. I've talked about um

00:02:50 - 00:03:44
just other numbers that that exist there. And for some people it's really hard for them to grasp that you can get those high numbers there. I'm going to break down exactly how that works, how those payments work. And um it might not be the case for you, but uh it also could be. So, I just want you to pay attention to that. And then I'm going to go through how to find Medicaid rates in your state and how to interpret those rates and what they're called, where you can look for them, and uh what that

00:03:17 - 00:04:13
means for you because this can be really helpful and insightful, especially for somebody if you're not used to uh getting into Medicaid and understanding exactly how that's going to work. Uh I think this will be something that's very helpful for you. All right. So, let's talk about Medicaid. What is it? Medicaid. It is well, let's let's do this. Medicaid versus Medicare. I always like to frame this up um when I do these videos where I talk a lot about Medicaid because uh these two things get confused

00:03:45 - 00:04:44
often. Medicare, let's start there. Medicare is a federally funded program. It's a federal pro program that is federally funded as well. It uh works with things like inpatient visits, outpatient visits, prescriptions. There's a few things that it does. It's it's basically a health health insurance that provides those beneficiaries that have that that benefit um with with care depending on the type of u of program that they have, the type of plan that they have elected to to go with. Uh but

00:04:15 - 00:05:13
at its core, that that's what it looks like. It does not include assisted living. It can include nursing homes. Um it can include home health, I believe. Um but those are because they are more clinical care. Assisted living is not clinical care. You can you will have a nurse in your home that is helping out with creating care plans and things like that, but the nurses are not providing clinical care. They're providing more oversight. They are delegating medication um down to residents or to to

00:04:44 - 00:05:47
the other staff so that they can take care of it. But the majority of the care provided is not clinical. um it is it's more um it's based off of the the needs of a resident and helping them out with activities of daily living. So that could be toileting, bathing, medication management, dressing, uh you know, getting ready for bed, feeding, um meal prep, all of those types of things is what we do inside of assisted living. Those are things that are not covered by Medicare. Medicaid, however, is a it's a

00:05:15 - 00:06:12
it's a federally funded program, but it's administered at a state level. Sorry. Um, so basically what that means is u there there are budgets that are set forth at a federal level. They this is very high level. There's there's more intricacies. Uh federal government says hey we've got a billion dollars we've got to give out to all of the different states for their Medicaid programs. We're going to give them um money and that money needs to be um outlined by the state how they're going to use those

00:05:43 - 00:06:44
funds. Right? So, a state can say, well, we want to have a chunk of that money that's coming to us that is based off of um you know, children. Uh could be like um could be what was the food stamps program um could be for elderly individuals who need help and assistance. Um things like like what we do in assisted living. So, uh they they basically say this is what we're going to use those funds for. They allocate it and then they set their their daily rates. We're going to talk about daily rates and fee schedules here

00:06:14 - 00:07:17
at the end of the video. So, make sure you stick around for that. Okay. But that is what Medicaid is. It is designed to serve underserved populations and oftentimes is going to include serving a a population that needs assisted living services. So, it's it's actually a really good program that that you can use inside of assisted living. One thing that I do want you to be aware of is you do not have to do Medicaid if you want to do assisted living. Not a requirement. Um, if you want to be

00:06:45 - 00:07:49
Medicaid, you're going to need to be a licensed provider, though. Unlicensed providers. Um, and this is this is a little bit of how Medicaid payments work. If you are an unllicensed facility, you cannot become a Medicaid provider in most states. I don't want to I I always try to avoid um uh you know, the hyperbolic statements. um because um I guess it's it's entirely possible that a state would um go the opposite way of this, but um I would say in almost every single case, you will need to be a

00:07:17 - 00:08:06
licensed provider, a licensed assisted living facility if you want to serve a Medicaid population. So, if you're thinking, "Oh, I want to do on license, but I also want to do Medicaid." You're not going to be able to blend those things. You need to pick one of them. And I'm not going to be mad at you for either one. It's just the reality of the situation. So, if you want to be doing Medicaid, then make sure you're a licensed provider. It's going to help you out. Um, the way that Medicaid's

00:07:42 - 00:08:34
going to work is there there's actually two pieces here. One is on the provider side, right? We have to become a licensed provider. We have to go through a uh a contract, a credentiing process uh that basically says here's our license, here's our insurance, here's uh everything that we are supposed to do as a provider. We're doing those things. Can we please be a Medicaid provider? Medicaid will then process that application, look at it, make sure you have all of the things in place that

00:08:08 - 00:09:05
make them feel comfortable that you're going to be able to serve the population, the resident population that needs these services. And if they agree with that, then they will give you your uh basically here here's your certification. You are now a Medicaid certified provider. And then on top of that, you're going to need to contract with every single Medicaid payer in your state. So, there could be thirdparty administrators, there could be managed care organizations, could be handled

00:08:36 - 00:09:30
directly with the the state's Medicaid. Um, could be a combination of those things. Um, in in Idaho, we have three different payers. In Colorado, when we were operating there, we just had one. So, just kind of is going to depend on the state, how they have it set up. But regardless, it benefits you to contract with every single Medicaid provider that is out there because a resident during the open enrollment period can choose to change their provider. And so if you are not contracted with a specific provider

00:09:03 - 00:09:54
for some reason and excuse me, your resident changes over to that other Medicaid provider, then you know if if you're not contracted with them, you're not going to be able to get paid and and so it's going to cause an issue. So, it's going to benefit you quite a bit if there are multiple payers in your state to get contracted with each of them. On the resident side, I mentioned, you know, there's two two sides here. One is the provider side, which is we just talked about. On the resident side, a

00:09:29 - 00:10:35
resident has to qualify for Medicaid, and they do that through a variety of means. Oftent times, it is there's a a large a large component of it is financial. Um, so they have to show a financial hardship, a financial means for needing to be on Medicaid. Um, there could also be uh certain disabilities or age can be a factor. There's several ways for a resident to qualify for Medicaid. So, you want to be aware of that. And sometimes as as a provider, you want to help your residents um figure out how they can qualify for

00:10:02 - 00:10:56
Medicaid because maybe they don't have the funds to pay you privately. But if you're able to get them to uh qualify for Medicaid, you can get some some reimbursement for that. So, it may be worth your time to figure out that process. Doesn't mean you should become a uh, you know, basically a social worker or case worker that is helping all of your residents do that. Um, maybe you actually partner with a caseworker or a social worker that can help you out with that. But the more that you

00:10:29 - 00:11:36
understand the process in your state, the better off you're going to be and be able to help your residents qualify for Medicaid and and receive that benefit. So, excuse me. Resident qualifies for Medicaid. Um, they they get their card that says, "Hey, you're a Medicaid beneficiary. You can go receive services at Medicaid certified uh locations." That's where they would come. They would find you because you're now a Medicaid provider. And when they come into your home, they are going to rece you're

00:11:02 - 00:11:49
going to receive um payment for the care that you are providing to them. You're going to need to have them come in very similar to what you would see with a private pay resident. Uh you're going to have them come into the home. Uh they are going to um have a care assessment by your nurse team uh or your nurse that's that's there at the facility. Your administrator should be involved in this. You should have standardized paperwork for it. Uh if you are interested in learning more about kind

00:11:26 - 00:12:31
of the the intake process, type in intake down below and I can do a video that is more specific to the intake process for when you're bringing in a resident into the home. But you're going to have them come in uh do that paperwork and then you're going to identify, okay, this resident uh we we like to do this kind of like on a on a scale um list. We have about 8 to 10 different things that we are evaluating on could be dressing, toileting, uh walking around, eating, uh medication, etc. And we typically will grade them on

00:11:58 - 00:12:47
a on a four-point scale, one to four. And then based off of where they are in in that range, that's uh the level of care that they will need. And then we would adjust rates based off of that. If they're private pay, if they are not private pay and they are on Medicaid, then we want to make sure that we're documenting all of those things so that we can take that back up to the state and say, "Hey, we're we're actually providing a lot more care. Can we um have an increase in the daily rate?"

00:12:23 - 00:13:27
That's it's core, that's kind of how that happens. But that daily rate that you're going to get reimbursed from Medicaid is going to be based off of the care needs that have been evaluated by the nurse in at the facility. And then a lot of states it just there's kind of two payment paths that you can see when it comes to Medicaid. One is one that I've talked a lot about on this channel and it is a combo payment is is what I would like to call it. Um it it is basically you get a daily rate. Let's

00:12:54 - 00:13:58
say it's a $100 per day. U there's 30 days in a month. That's $3,000 that you're going to receive for that. So very easy basic math, right? So that that's one method. And then on top of that, you're going to collect what we call a rough payment RUF, which stands for rent, utilities, and food. And that is going to be a portion of their social security income. So let's say they receive $1,000 in social security income on a monthly basis. we get to collect 858 $850 to $900. The state will tell

00:13:27 - 00:14:19
you how much uh how much you're going to collect. The rest of that money they can use however they want. There's two reasons for that, by the way. One is you're providing them with pretty much everything. So, they don't necessarily need funds for for extra stuff. And two, they have to maintain their Medicaid eligibility, which includes spending down all of their money um and not having a lot of it in the bank. it's there's just kind of some give and take in the Medicaid process. So that's

00:13:53 - 00:14:46
that's number one. You can you can receive payments where it's um daily rate plus a rough payment which comes from the social security of the resident. The other path and I see this in in multiple states is there is just one daily rate. There's no rough payment where you're getting social security income. Social Security actually uh kind of comes through the process and like I I I don't understand exactly how it works, but I believe it kind of comes through uh goes into like a Medicaid

00:14:19 - 00:15:14
pool and then that daily rate is actually higher. Let's say it's $150 um for for uh for the services that you're providing, but you're not going to get something on the back end. So $150 per day, 30 days uh in a month, that's $4,500. Just trying to keep math really, really basic here, right? uh to to make my life a little bit easier as I'm doing math on the fly. So, that's something that uh that you want to keep in mind is you're probably going to have one of those two paths. Uh that's that's

00:14:47 - 00:15:43
how those payments are going to work and and what you should be looking for and paying attention to as you are trying to to figure out a lot of this to see if if Medicaid payments are going to work for you. So, let's now talk about how Medicaid payments or how Medicaid rates are going to work in your state because this is something where I think there's a lot of confusion uh from a lot of people. You need to number one to figure out what this is, you have to look for a fee schedule. So, if you look online and

00:15:15 - 00:16:04
a fee schedule is basically a table uh just like a like an Excel table that is going to tell you, hey, here's here's the rate. Uh here's the amount that we paid for it and here's the units that you can bill. Um and and sometimes like if you're looking at more of a clinical type of a of a setting, you're going to see things like 15minute increments. Um but when it comes to assisted living, there's just one daily rate. Um and it's all-encompassing for for everything. If

00:15:39 - 00:16:41
you want to find the Medicaid fee schedule in your state, you should do an internet search for something like that. Medicaid fee schedule in my state. You know, if it's Utah or California, New York, wherever it is that you're you're doing this in, just do a search for Medicaid fee schedule in my state. You're going to get a lot of results there. Make sure you find the most recent one, the most current version of this. They'll have it like an updated date on there so you can see exactly

00:16:10 - 00:16:56
when that is. pay attention to that because if you find a fee schedule that's from 2012, it's probably not accurate. Your rates are going to be off. You need to find something that's probably they don't update them on an annual basis. Some states do, but generally they don't. But if you find something that's like in the last 2 to 3 years, you could probably feel pretty confident that the rates are accurate or at least close enough to accurate that that you don't need to worry about it.

00:16:33 - 00:17:29
If you find something that's 10, 20 years old, don't pay attention to it. It's old. It's out of date. uh there there's got to be something better out there. Usually this information is found on their website. Um but it can be hard to find their website. I found that doing an internet search for those specific terms, Medicaid fee schedule in my state is going to be the best way for you to identify this. Uh just it seems to work in in most states uh that I've looked up. Now that that table of rates is what

00:17:01 - 00:17:56
you're going to get. It's going to be a PDF document. It's not generally not an Excel document. Usually it's a PDF. um sometimes a word document, usually a PDF, and it's going to be who knows anywhere from five to 50 pages long. Uh some states will kind of split this up between the different types of eligibility for a resident and the type of care. So, you just want to pay attention to what type of waiverss am I going to get into. If you're interested in learning more about waiver programs,

00:17:28 - 00:18:20
just type in waiver down below. We can talk about that a little bit. uh because there's different you get certified as a Medicaid provider, but then you are also certified to uh provide uh care to different waiver programs that a resident would qualify for Medicaid on. So, if you're interested in learning more about that, just type in waiver down below. We'll do a separate video on that. What you need to be looking for once you found that fee schedule, you have that table, that PDF, you know,

00:17:54 - 00:18:50
it's 10 pages long, whatever. Uh you are going to want to look for rates that are associated with assisted living. They oftentimes do not call it assisted living though. So you need to look on there for something. It could something like residential services, uh residential care. Uh you don't want to be doing inhome care because this is different from that. But you want to be looking for some kind of program that is assisted living or assisted living adjacent. And you can always reach out

00:18:22 - 00:19:26
to the state to to the to the Medicaid office to get clarity on exactly what that is. Once you find the rate, you're going to identify on that table if it says it's a max or a minimum rate or if it's just a flat rate. Sometimes they don't say this. Uh but this is something I was working with one of my with one of my students um and she's actually looking at starting a facility here converting a few homes here in Utah and we were looking at the the fee schedule rates um for the type of of resident

00:18:54 - 00:19:55
that she wants to be serving. And the fee schedule on there actually said the max daily rate for this type of service. Um, and I I think the the rate was like 300 to $350 per day. So, uh, this is something that I I had a comment uh, somebody a gentleman um, and I I'm not calling you out on this one at all, but asked some very detailed questions on a on a YouTube video recently about like wanting to see screenshots of of my explanation of benefits and and the way that I uh, bill and and I'm not going to

00:19:25 - 00:20:12
do that. like I I'm just I I don't have the time for it and I'm I'm sorry. Like I'm just not going going to do that. But I will say that you can find these rates and you need to pay attention to what those fee schedules are saying to you because they may say, "Hey, the minimum rate here is $80 a day." And you take that as, "Oh man, it's only $80 a day." Whereas, we looked at this one in Utah. We found it uh for the fee schedule for the type of resident she's going to be

00:19:48 - 00:20:53
serving, and it was $300, $325 per day. But it also says maximum amount. So yeah, potential for $300 per day for that one resident. Times that by 30 days, that's $9,000 in a month for this one resident, which is great, right? But, uh, at what level is is the resident going to be? That that's what remains to be seen. And so, could the actual daily rate for that specific resident be somewhere closer to $1, $150 a day? Probably. But there's the the ability to get up. So pay attention to

00:20:21 - 00:21:11
what your your fee schedule's going to say because it may say something different. It may have just a flat rate. It may only say that that's that's the only rate, but I would also push back on that and see uh if there are ways for you to demonstrate more care, if there are other codes that you can bill. There's a lot of things in this world of billing and coding that you need to be aware of. And that's something that is confusing and and a little bit overwhelming when it comes to Medicaid,

00:20:46 - 00:21:40
but it's something that you want to be aware of because it can have a a huge impact on the amount of uh you know the volume of money that you're going to be able to obtain through through working with this. So, always ask for clarification if it's unclear to you what your what your what those rates are going to look like. if it's a min or a max rate or a flat rate, you want to be asking for clarification because if you just make an assumption and then you do your underwriting, which by the way, get

00:21:13 - 00:22:03
over to assisted livinginvesting.net, grab your free underwriting calculator. It's right there at the top of the of the page and that's going to help you out. But you need to underwrite the opportunity. You need to understand if it's going to make sense for you financially before you jump into it and ask for clarification then on those Medicaid rates. In the 24-month proform on that calculator that I give you for free, you're going to see a spot where it can say, "Hey, is this Medicaid or is

00:21:38 - 00:22:33
this private pay?" Um, and what are those rates going to look like? See what you can find on the fee schedules. And then you're going to fill that out in the calculator. And then you're going to just use a basic formula and say the the income per month potential multiplied by the amount of residents I'm going to have in my facility. That's my income earning potential. And potential is a very important word there. Uh take this as like real potential, not oh cool, like I'm going to have 5 10 15 20

00:22:06 - 00:23:00
residents in my home, so I'm always going to have x amount of money. you should always try to uh do your underwriting at 80% or less and see what your break even point is before you move forward with something because what I really don't want you to do is get into a position where you are losing money because you made an assumption that you would always be 100% full and that just frankly it's not going to happen. Uh we we are going through this process. We just had a resident pass away at our

00:22:33 - 00:23:23
facility. We're having another one leave here um at the end of the month. Uh luckily we've been able to fill the bed for the person that passed away. Um we have the person leaving at the end of the month. We have a few people that are lined up uh that we'll have conversations with to see which one is the best fit to come into the facility. This is happening all the time. Like we I would say almost on a monthly bimonthly basis. We are having some kind of fluctuation in our residents and so

00:22:58 - 00:23:45
uh there are times where we go weeks at a time without a resident and that is income uh earning potential that is lost. And so you just need to be aware of that as you're getting into the facility. Make sure you have really good marketing processes in place. That's going to help you out as you're trying to uh to get more people. All right, that's a little bit outside the scope of what we talk about here talking about here in this video. Again, we have been talking about Medicaid, what Medicaid

00:23:22 - 00:24:12
is. We talked about how Medicaid payments are going to potentially work for you and then how to find those Medicaid rates in your state and what you should really be looking for when it comes to that. and if you can make adjustments based off of those. Are you looking at a min or a max um amount there for it and and then dig into it and try to really understand ask a lot of questions is what you need to be doing. Now, if you found this video helpful, make sure you like the video, subscribe, ring the bell as well so you

00:23:47 - 00:24:37
get notified every time we put out content like this. Uh generally we go live on Tuesdays except for our weeks where we do a live challenge and then we put out content on Thursdays as well. On when it comes to challenges, I would love to see you at the next one. Go to roadmapchallenge.com. would love to see you there. It's a live challenge. We go through a ton of stuff helping you build a road map that's going to help you kind of make the progress that you need to make so you can be ready to launch an

00:24:12 - 00:24:55
assisted living business. Uh we talk about numbers, um how to understand underwriting. We're going to talk about the different pathways to get into assisted living. We're going to talk about funding. We're going to talk about licensing. just kind of give you a really broad overview of what you're getting into when it comes to assisted living so you know what to expect and how to determine if this is really going to be a good fit for you or not. So, if that's something that you're just

00:24:34 - 00:25:20
struggling with, you're trying to figure out, roadmapchallenge.com is the spot for you. Uh would love to have you in there. And if you get a VIP ticket, you're going to get extra time with me. You can ask me whatever questions you want. I am an open book. I love helping and coaching people. I love my VIP people. Um we just had a challenge last week and it was so much fun. Um, we we dove deep into several questions and I I just I loved it. It was it was a ton of fun. So, would love to see you at the

00:24:56 - 00:25:47
next challenge, roadmapchallenge.com. If you are like you're like, I got to work with this guy. I want to work with him and and but I don't know how to do it, go to aliquiz.com. I have a 30-cond quiz. You can take that or just go to assisted livinginvesting.net. It's right there at the top of the of the page. You can also get my book um the profitable assisted living facility right here. Go to thebook.com. Uh it the Audible version of it is just getting approved right now on Audible.

00:25:22 - 00:26:11
So that will be available soon as well. We'll have links over at the alibook.com if you want that the workbook um or or the physical book. Uh whichever one you want, you're going to make sure that you get access to those over on that website. Are you curious about assisted living, but you're not sure how to get started? At Assisted Living Investing, I help first-time assisted living entrepreneurs launch profitable, purpose-driven businesses, creating prosperity, purpose, and peace in their lives. I

00:25:46 - 00:26:24
love helping and coaching people. And I would love to help you along your path to launching your assisted living business. And remember, it doesn't take a lot, just a little bit. Just keep going step by step by step. And I promise you, if you do, and you are consistent and persistent, you are going to be successful. Thanks for watching and have a great day.